[Ultrasound examination of nerves of the upper extremities]. / Nervensonographie der oberen Extremitäten.

The ultrasound examination of peripheral nerves has been further developed in recent years and is recognized as an independent discipline by the German Society of Ultrasound in Medicine (DEGUM). A systematic ultrasound examination of the musculoskeletal system is not limited to the joints, muscles and bones but should also include the examination of nerves and blood vessels. Therefore, in the practice of ultrasound examination every rheumatologist should have at least a basic knowledge of the ultrasound examination of the peripheral nerves. In this article the authors present a landmark-based concept in which the three large nerves of the upper extremities can be completely visualized from proximal to distal and evaluated.

Climate-driven variability of the Southern Ocean CO2 sink.

The Southern Ocean is a major sink of atmospheric CO2, but the nature and magnitude of its variability remains uncertain and debated. Estimates based on observations suggest substantial variability that is not reproduced by process-based ocean models, with increasingly divergent estimates over the past decade. We examine potential constraints on the nature and magnitude of climate-driven variability of the Southern Ocean CO2 sink from observation-based air-sea O2 fluxes. On interannual time scales, the variability in the air-sea fluxes of CO2 and O2 estimated from observations is consistent across the two species and positively correlated with the variability simulated by ocean models. Our analysis suggests that variations in ocean ventilation related to the Southern Annular Mode are responsible for this interannual variability. On decadal time scales, the existence of significant variability in the air-sea CO2 flux estimated from observations also tends to be supported by observation-based estimates of O2 flux variability. However, the large decadal variability in air-sea CO2 flux is absent from ocean models. Our analysis suggests that issues in representing the balance between the thermal and non-thermal components of the CO2 sink and/or insufficient variability in mode water formation might contribute to the lack of decadal variability in the current generation of ocean models. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

[Rehabilitation of orphan diseases in adulthood: osteogenesis imperfecta]. / Rehabilitation seltener Erkrankungen im Erwachsenenalter: Osteogenesis imperfecta.

Osteogenesis imperfecta (brittle bone disease) is an orphan disease caused by a genetic mutation in collagen metabolism. Bone fractures are the most common symptoms; however, the clinical manifestation can vary widely. Additional features can include blue sclera, dwarfism, bone deformities, muscular weakness, scoliosis, hearing loss and hypermobility of joints. Most patients show a reduction of skeletal function. This leads to an increased risk of being unable to continue their former work and to participate in social life. A comprehensive treatment includes drug therapy, surgery and rehabilitation. This article gives an overview of the current status of rehabilitation in adult patients with osteogenesis imperfecta.

Quantification of Chaotic Intrinsic Variability of Sea-Air CO2 Fluxes at Interannual Timescales.

Chaotic intrinsic variability (CIV) emerges spontaneously from nonlinear ocean dynamics even without any atmospheric variability. Eddy-permitting numerical simulations suggest that CIV is a significant contributor to the interannual to decadal variability of physical properties. Here we show from an ensemble of global ocean eddy-permitting simulations that large-scale interannual CIV propagates from physical properties to sea-air CO2 fluxes in areas of high mesoscale eddy activity (e.g., Southern Ocean and western boundary currents). In these regions and at scales larger than 500 km (~5°), CIV contributes significantly to the interannual variability of sea-air CO2 fluxes. Between 35°S and 45°S (midlatitude Southern Ocean), CIV amounts to 23.76 TgC yr-1 or one half of the atmospherically forced variability. Locally, its contribution to the total interannual variance of sea-air CO2 fluxes exceeds 76%. Outside eddy-active regions its contribution to total interannual variability is below 16%.

[Sonography of the foot in rheumatology : Ultrasound diagnostics of the ankle joint and foot in the rheumatological routine]. / Fußsonographie in der Rheumatologie : Sonographische Diagnostik des Sprunggelenks und des Fußes im rheumatologischen Alltag.

Ultrasound examination of the joints is an essential component of diagnostics in rheumatology. Due to its easy accessibility, excellent image definition of soft tissue and bone surfaces with standardized scan sections and scoring systems, ultrasound examination of the joints enables decisions to be made on early and differential diagnostics, treatment monitoring and prognosis. Involvement of the ankle and foot is a common problem in both inflammatory and degenerative rheumatological diseases. Persisting inflammatory processes and bone destruction increase the burden of disease by causing a loss of mobility due to pain. As treatment is often prolonged it is an important issue for both the quality of life of affected patients and a burden on the resources of the healthcare system. The anatomical characteristics of the foot make it difficult to draw diagnostic conclusions by physical examination only. These diagnostic gaps in the remaining rheumatological questions can often be answered by ultrasound examination of the joint.

[Osteomalacia-Clinical aspects, diagnostics and treatment]. / Osteomalazie ­ Klinik, Diagnostik und Therapie.

Osteomalacia is a bone disease caused by impaired skeletal mineralization. Vitamin D dependent types have to be distinguished from hypophosphatemic forms. Typical signs and symptoms include diffuse bone pain, muscle weakness and fragility fractures. The fracture pattern in osteomalacia is typically different from that of osteoporosis. Fragility fractures of the pelvis, sacrum, distal parts of the foot, proximal tibia and ribs are indicators for osteomalacia, whereas femoral neck and vertebral fractures (wedged vertebra, fish vertebra, vertebra plana and cover plate impression fractures) are typical for osteoporosis. Unspecific clinical features may be the reason for a delayed diagnosis. The correct classification of the complaint is dependent on the knowledge of the pathophysiology of osteomalacia and performance of additional bone-specific examinations. Determination of specific laboratory parameters should follow a rational algorithm, supplemented by imaging methods and a bone biopsy.

[Spinal orthoses in the treatment of vertebral fractures with osteoporosis : A systematic review article]. / Rückenorthesen in der Behandlung von Wirbelkörperfrakturen bei Osteoporose : Eine systematische Übersichtsarbeit.

This literature search concerning the potential role of spinal orthoses for rehabilitation and treatment of atraumatic vertebral fractures between Th4 and L5 with osteoporosis and without any evidence for a secondary cause, provided no evidence for the benefits of traditional rigid thoracolumbar corsets, which only had a poor compliance. In addition, there are indications that these rigid corsets may even worsen the disease condition especially in the long-term. Wearing these corsets can result in further loss of muscle mass and strength followed by loss of bone and bone mass. Both together can worsen the functional capabilities of patients. On the other hand the functional capabilities of patients suffering from acute or subacute vertebral fractures due to osteoporosis can be improved by flexible backpack orthoses. These spinal orthoses generate an extension moment about the spine, increase perception of one's own body posture via biofeedback and therefore lead to improved posture. This results in a strengthening of the trunk musculature, a more stable equilibrium and a reduction of pain, which are associated with an increase in functional capabilities and improvement in the parameters of the quality of life. During a long-term phase of rehabilitation individually tailored spinal orthoses guarantee a high level of compliance and adherence. Finally, there is high-quality evidence that spinal orthoses with additional weighting can improve the equilibrium in women with vertebral osteoporosis and hyperkyphosis. Future studies should also be carried out with other groups of patients.

[Pregnancy and lactation-associated osteoporosis]. / Schwangerschaftsassoziierte Osteoporose.

Pregnancy and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis, which occurs in the last trimester or postpartum. So far 100 cases have been published. The leading symptoms are severe low back pain or less frequently hip pain. Many patients develop postpartum depression due to inability to care for the baby and vertebral fractures. The therapeutic decision has to be made individually but teriparatid and bisphosphonates seem to be the best option. We report the clinical course (16 years) of a 37-year-old patient with PLO, who suffered 6 vertebral fractures. There were severe physical limitations and mental problems caused by the disease. The patient was treated by multimodal therapy including physiotherapy and psychotherapy and bisphosphonates were given. The time between the onset of symptoms and diagnosis was 5 months. No further fractures occurred in the following 16 years. The physical and mental condition significantly improved.

[Severe therapy refractive osteoporosis : A rare differential diagnosis]. / Schwere therapierefraktäre Osteoporose : Eine seltene Differenzialdiagnose.

Systemic mastocytosis is defined as a clonal increase of mast cells. We report on four patients with severe osteoporosis and histologically confirmed systemic mastocytosis. In spite of antiresorptive therapy the patients developed further vertebral fractures and suffered from ostealgia. Systemic mastocytosis is an important differential diagnosis in patients with therapy refractive and unexplained osteoporosis. Skin involvement (urticaria pigmentosa) is a rare occurrence and in most cases an isolated involvement of bone marrow is present. Determination of serum tryptase can provide indications for systemic mastocytosis but the diagnosis is only confirmed by bone marrow biopsy. There is a high risk of vertebral fractures and patients should be treated in specialized centers. Zoledronic acid can be a therapeutic option for indolent osteoporosis associated with systemic mastocytosis.

[Brain stem infarction, temporal headache, and elevated inflammatory parameters in a 74-year-old man]. / Hirnstamminfarkt, temporaler Kopfschmerz und erhöhte Entzündungsparameter bei einem 74-jährigen Patienten.

We report the case of a 74 year old man with a brain stem infarction, temporal headache and elevated inflammatory parameters. Giant cell arteritis with involvement of the temporal and vertebral arteries was proven by histology, duplex sonography and MRI. Although intensive immunosuppressive therapy was started, the patient developed two brain infarcts within 6 months. Initially, C­reactive protein and erythrocyte sedimentation rate were significantly elevated, but normalized over time. Involvement of the vertebral artery in giant cell arteritis is thought to be rare; steroid refractory courses are very rare. Brain stem infarction might be the consequence.

[A 58-year-old patient with temporal headache, jaw claudication and B symptoms]. / Ein 58-jähriger Patient mit temporalen Kopfschmerzen, Kauclaudicatio und B-Symptomatik.

CASE REPORT: We report the case of a patient with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with involvement of the temporal artery, presenting with clinical manifestations of giant cell arteritis and temporal arteritis, such as temporal headache, jaw claudication, weight loss, night sweats and increased inflammatory parameters. The ultrasound scan showed a typical halo sign of the temporal artery. DIAGNOSTICS: In the case of further atypical organ symptoms, e.g. hematuria and proteinuria, detailed differential diagnostic investigations are essential to clarify the situation. Histological findings from the affected organs play a decisive role. CONCLUSION: An involvement of the temporal artery due to ANCA-associated vasculitis is extremely rare and may mimic giant cell arteritis. The exact diagnosis of ANCA-associated vasculitis is, however, important because this leads to a different approach concerning therapy and prognosis.

[A 48-year-old patient with oligoarthritis of the knees, having excluded spondyloarthritis and rheumathoid arthritis]. / 48-jähriger Patient mit Schmerzen und Schwellungen beider Kniegelenke bei Ausschluss einer Spondyloarthritis und einer rheumatoiden Arthritis.

We report the case of a patient with amyloid light-chain (AL) amyloidosis, presenting for more than 1.5 years with oligoarthritis as the only clinical symptom of the underlying disease. Developing further organ symptoms (heart and gastrointestinal tract) led to the definitive diagnosis. Joint involvement due to AL amyloidosis is extremely rare and may mimic rheumatoid arthritis. Arthritis might be the first symptom of the AL amyloidosis. The combination of arthritis and other organ disorders (e.g., proteinuria, heart failure, or diarrhea) should initiate further diagnostic efforts considering AL amyloidosis as a differential diagnosis. The diagnosis will be confirmed by the typical histology of synovia or involved organs including immunohistochemistry for typing amyloid and performing immunoelectrophoresis.

Synthesis, structure, electronic and vibrational spectra of 9-(Diethylamino)-benzo(a)phenoxazin-7-ium-5-N-methacrylamide.

The electronic and vibrational spectra of 9-(Diethylamino)-benzo(a)phenoxazin-7-ium-5-N-methacrylamide (Nile Blue-5-N-methacrylamide) are measured, and the results are compared with the theoretical values obtained by quantum chemical calculations. The geometry, electronic transitions, charge distribution, and the IR normal modes of this new dye and of its precursor Nile Blue have been computed by using Density Functional Theory (DFT) method with the functional B3LYP and the 6-31G(d) Gaussian basis set. The molecular properties of the two dyes, predicted and observed, are very similar in the electronic ground state. In the excited state, however, the longer lifetime and larger fluorescence quantum yield of the Nile Blue-5-methacrylamide is ascribed to an inhibition of the twisted intramolecular charge transfer (TICT) process, when the NH2 is substituted by the methacrylamide in the 5-position of the aromatic extended ring of the dye. The change in charge density of the N atom in 5-position, as well as the difference in dipole moment and ionization potential of the two dyes molecules, explain the attenuation of TICT process. The vibration spectra of both dyes are simulated properly by using the DFT method.

Genetic variation in homothallic and hyphal swelling isolates of Pythium ultimum var. ultimum and P. utlimum var. sporangiferum.

Genetic variation in a collection of 22 Pythium ultimum isolates was analyzed using restriction fragment length polymorphisms (RFLPs), random amplified polymorphic DNA (RAPD), and sequence characterized amplified regions (SCARs) as genetic markers. Qualitative evidence for the occurrence of sexual outcrossing in the field, asexual mechanisms affecting variation, and differences in aggressiveness between isolates was found. Codominant SCAR and RFLP markers detected multiple alleles in several isolates. Genetic analysis of F1 progeny from a cross indicates that heterozygosity is one cause of multiple alleles and contributes to genetic variation. Segregation analysis of F2 progeny fit diploid expectations and supported the use of the molecular markers for phenetic analysis. One isolate contained three alleles at one locus suggesting that polyploidy, aneuploidy or heterokaryosis may also contribute to genetic variation. Phenetic analysis using UPGMA clustering of Nei's distance calculated from RFLP data, UPGMA clustering of similarity matrixes calculated from RAPD data, and principle component analysis of RAPD data revealed no clustering of the three morphological types of Pythium ultimum (var. ultimum, var. sporangiferum, and group HS). Our results suggest that the three morphological variants of this homothallic oomycete are not genetically distinct.

Physiological characterization of heterotrophic bacterial communities from selected aquatic environments.

Three different biotopes, groundwater, surface water, and activated sludge, were examined and the total colony count on nutrient agar determined. The bacteria that could be isolated from the agar plates were identified and their in vitro activities investigated. Three principal approaches were used: (1) isolates were identified and the results used in a numerical analysis to determine their similarity; (2) the different physiological properties of isolates originating from a single biotope were compiled and used to characterize the community (collective total activity); and (3) the diversity of the physiological properties of the isolates of all populations was determined; on the basis of main characters a "heterotrophic" diversity index was calculated. The possibility of using a polyphasic ecological study to characterize aquatic bacterial communities is considered.